addressing obesity by changing environments kelly d. brownell yale university
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Addressing Obesity ByChanging Environments
Kelly D. BrownellYale University
www.YaleRuddCenter.org
Nutrition in schools
Sugared beverages & taxes
Food marketing and children
Examples ofMajor Initiatives
Food labeling
A Conceptual Scheme
Knowledge
Motivation
How Best to Make Change?
Educate
Implore
Medicate
Operate
TheIndividual
Less Obesity?
CDC, BRFSS
% of US Population GettingRecommended Physical Activity (1986-2000)
NHANES
% of US Adults GettingRecommended Fruit & Vegetable Servings
0
20
40
60
80
100
1994 1996 1998 2000 2003 2005
Youth RiskBehav Survey
% of US Children GettingRecommended Fruit & Vegetable Servings
0
20
40
60
80
100
1999 2001 2003 2005 2007
What Are We Doing Now?
Knowledge
Motivation
Educate
Implore
TheIndividual
Less Obesity?
Knowledge
Motivation
How Best to Make Change?
Educate
Implore
Medicate
Operate
TheIndividual
Less Obesity?
OptimalDefaults
Economics
Legislation
Environment
Regulation
TheIndividual
Less Obesity?
Another Example – Organ Donation
Johnson & Goldstein, Science, 2003“Do defaults save lives?”
Disastrous Defaults(examples)
• The economics of food
• Food marketing
• Portions
• Too much access
• Too little access
Food Marketing
Food Marketing
Powerful
Relentless
Exploitative
TVAdvertising
Adver-gaming
Other YouthWebsites
Bunnies
Life
Hannah Montana
Clifford Crunch
Mighty Bites
Honey Sunshine
Puffins
Cheerios
Kix
EnviroKids Organic
Mini Wheats
Organic Wild Puffs
The Best Dozen
None
TVAdvertising
Adver-gaming
Other YouthWebsites
x x x
x
x x x
x x x
x x x
x x x
x x x
x x
Reese’s Puffs
Cap’n Crunch
Count Chocula
Trix
Froot Loops
Smorz
Lucky Charms
Golden Grahams
Cinnamon Toast Crunch
Corn Pops
Cocoa Puffs
Fruity/Cocoa Pebbles x x x
The Worst Dozen
RWJF $100million/yr
vs.Child
Marketing
January 4!
The Special Case ofSugar-Sweetened Beverages
The World’sMost Valuable Brand?
% Calories Per Day From 2 Beverages
Nielsen & Popkin. Am J Prev Med, 2004
0
2
4
6
8
10
1977-78 1989-91 1994-96 1999-2001
Milk
Soft Drinks
• Single greatest source of added sugar
• Poor calorie compensation
• Targeting of vulnerable populations
• Sugar may be addictive
• Gratuitous addition of caffeine
• Completely empty calories
Why Soda?
• Rock solid proof of harm
SSBs: How Much?
Average intake = 50 gallons/yr (189 liters)
Average child = 175 calories/day
Children Ages 2-18
Empty calories = 40% of total intake
Largest contributor to overall intake SSBs + Juice Drinks, 173 kcal/day
Reedy & Krebs-SmithJ Amer Dieteitic Assn, 2010
Brownell et al.New Engl J Med, 2019
How Worriedis Industry?
Millions Spent Lobbying Coke & Pepsi + ABA
Los Angeles TimesFeb 7, 2010
Household Budget SurveysExpenditure records (all beverages)Household income & number of residents
Industry ReportsMarket volume & market value
Sugared Beveragesin Latin America
UnderestimatesCaptures about 50% of intake
Data: Datamonitor 2009, Euromonitor 2009, Andreyeva et al 2011
Consumption TrendsPeru, 1997 - 2009
Data: Peru, Encuesta Nacional de Hogares
Consumption TrendsMexico, 1984 - 2008
Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares
Consumption Trends & Income
Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares
Consumption Trends & Income
Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares
Estimated Revenue (20% tax)
$2.66 billion
$256 million
$857 million
$2.37 billion
Brazil
Chile
Colombia
Mexico
Peru $191 million
Revenue (US Dollars)
Calculations based on Datamonitor 2010, Euromonitor 2010, World Bank 2009
Who Are TheChange Agents?
Legislators federal, state, local
Legal Authorities e.g., state attorney’s general
The Press
Litigators
Dr. Thomas FriedenNYC Commissioner of Health
Michael BloombergMayor
LegalDefaults
Game ChangingDevelopments
NYC trans fat ban in restaurants
Menu labeling
White House Announcements
Soda tax proposals
Conn. Attorney General – Smart Choices
www.YaleRuddCenter.org
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